A Rare Case of Acute Pericarditis as a Primary Presentation of Differentiation Syndrome

Abstract

A 47-year-old male with a history of acute promyelocytic leukemia was admitted for his induction chemotherapy session with all-trans retinoic acid and arsenic trioxide. On day 25, his medical course became complicated with differentiation syndrome and he developed isolated acute pericarditis.

Successful Treatment of Recurrent Pericarditis With Rilonacept in Acute Promyelocytic Leukemia

“…According to these cases, typical pericarditis treatment consisting of NSAIDs, colchicine, and corticosteroids, with close follow-up to monitor for recurrence, may be used to treat pericardial effusions and acute pericarditis linked to ATRA or ATO use and DS. 9 , 10 Recurrent pericarditis in the context of APL has not been documented in any cases in the literature, so the standard of treatment is not known.…”

Differentiation Syndrome in Acute Leukemia: APL and Beyond

“…Table 1 lists the most common symptoms of DS. In addition to the more commonly seen symptoms of DS in patients with APL, there have been several atypical presentations reported in the literature, including atypical cardiac manifestations, pancreatitis, and ocular manifestations [32,[34][35][36][37][38][39][40]. The atypical cardiac presentations of DS include myocarditis, pericarditis, or myopericarditis [34,[40][41][42].…”

“…In addition to the more commonly seen symptoms of DS in patients with APL, there have been several atypical presentations reported in the literature, including atypical cardiac manifestations, pancreatitis, and ocular manifestations [32,[34][35][36][37][38][39][40]. The atypical cardiac presentations of DS include myocarditis, pericarditis, or myopericarditis [34,[40][41][42]. These cardiac manifestations usually present with symptoms of chest pain and demonstrate EKG changes consistent with the cardiac pathology, such as QRS amplitude depression or diffuse ST elevations.…”

“…Acute kidney injury (AKI), presenting as elevated creatinine and blood urea nitrogen, is a listed criterion for DS and occurs in 11−66% of patients with DS [11,13,17,33]. Finally, in cases of hypervolemia or cardiac manifestations of DS, patients can develop elevated troponin and pro-BNP [19,34,[40][41][42].…”